Health-care officer finds that change comes slowly

In January 2003, Gov. Ed Rendell established the Pennsylvania Office of Health Care Reform to improve the accessibility, affordability and quality of health care. Two-and-a-half years later, many people still don't know the office exists. That doesn't bother Rosemarie Greco. "We have tried to keep a very low profile," said Greco, a Philadelphia businesswoman who became the office's director in 2003.

During Greco's tenure, the office has quietly worked to develop medical-malpractice reforms, lower the state's pharmaceutical costs and improve long-term care. Its profile could be raised, however, as it works on an initiative to ensure universal health-insurance coverage in Pennsylvania. Finding new ways to provide insurance is vital because it is getting harder for both businesses and governments to afford to keep people covered, Greco said.

"It's becoming more and more of a burden," she said.

In May, the Pennsylvania Insurance Department released extensive data about health-insurance coverage statewide. There are 900,000 uninsured Pennsylvanians, according to the data.

The data gives the Office of Health Care Reform a road map it can use to develop strategies to cover more people, Greco said. The office received a $900,000 planning grant from the U.S. Health Resources and Services Administration. The work will include gathering comments from a variety of stakeholders, including insurers, employers, health-care providers and unions.

Each group will have to make sacrifices to improve access to health insurance, Greco said. Consumers might have to give up unhealthy behaviors. Lawmakers might have to stop adding to the state's list of benefits that insurers are required to provide.

"We will not see systemic change until everyone comes to the table," Greco said.

The strength of Greco's office is that it reaches out to different constituencies within the health-care industry, said Dr. Daniel Glunk, chairman of the Pennsylvania Medical Society in Lower Paxton Township, Dauphin County. The society has worked with the office on efforts to reform Pennsylvania's medicalmalpractice system.

"We've had a very good working relationship with the Office of Health Care Reform," said Glunk, an internist practicing in Williamsport. " ... (The office) has really had a daunting task trying to bring everyone together."

The office also uses its coordination skills in its work to improve long-term care. Among the office's initiatives is a pilot project that makes it easier for people in nursing homes to receive care in their own homes.

The Office of Health Care Reform recognizes the need to streamline the regulation of long-term care providers, said Alan Rosenbloom, president of the Pennsylvania Health Care Association. The Harrisburg-based organization represents long-term care providers statewide. Numerous state agencies handle regulatory oversight for such care, including the departments of health, public welfare and aging. This causes confusion for providers and regulatory gaps that could harm consumers, Rosenbloom said.

"The idea of coordinating these different agencies is a good one," he said.

Greco acknowledged that the job of reforming health care has been more difficult than she thought it would be when she came to the office after a career in the business world, including time as president and chief executive officer of the former CoreStates Bank, which is now Wachovia.

Many health-care issues facing Pennsylvania are complex, and any reforms require a lot of forethought, she said. For example, many states are considering importing prescription drugs from other countries in an attempt to lower drug prices. Pennsylvania could try such an approach, but it would probably elicit an angry response from pharmaceutical companies that employ people statewide, Greco said.

The Office of Health Care Reform will continue to try to forge relationships between state agencies and other stakeholders in the health-care system. Greco believes that those partnerships will help reforms happen more quickly.

"It will be very challenging work, but we have to stay focused," she said.